Blood-pressure-determining device.



B. R. HOOBLER.

BLOOD PRESSURE DETERMINING DEVICE.

APPLICATION TILED JAN.17, 1912.

1,043,521. Patented Nov. 5, 1912.

2 SHEETSSHBET 1.

B. vR. HOOBLER. BLOOD PRESSURE DETERMINING DEVICE.

APPLICATION FILED JAN. 17, 1912.

, 1,043,521, Patented Nv.5, 1912.

2 SHEBTS-SHEET 2.

g q LA L a 9 w IA/ IH M N o cf 0 n wi/lmwoeoz 51mm vyfoz v I 951 dttow 3 BEST AVAILABLE COPY BERTIE RAYMOND HOOBLER, OF NEW YORK. N. Y.

BLOOD-PRESSURE-DE'IERMINING DEVICE.

Specification of Letters Patent.

Patented Nov. 5, 1912.

Application med January 17, 1912. serial'no. 671,750.

To all whom itmay concern:

Be it known that I, Bnn'rm R. HOOBLER, a citizen of the United States, and a resident of New York, in the county of New York and State of New York, have invented certain new and useful Improvements in Blood- Pressure-Determining Devices, of which the following is a Specification.

The invention relates to apparatus for determining and indicating blood pressure, or the degree of blood pressure, and more particularly to apparatus for determining both the systolic pressure and the diastolic pressure.

The objects and advantages of the present invention will be in part set forth hereinafter, and will in part be apparent herefrom to those skilled in the art, and the means by which said objects and advantages are attained will be set forth in the accompanying claims.

The invention consists in the novel parts, arrangements, constructions, combinations and improvements herein shown and described.

The accompanying drawings, referred to herein and forming a part hereof, illustrate one embodiment of the invention, the same serving in connection with the description herein to explain the principles of the invention.

Of the drawings: Figure 1 shows a device or apparatus embodying the principles of the invention applied to a human arm; Fig. 2 is an interior View of the device which is shown wrapped about the arm in Fig. '1, the

device being extended out flat; and Fig. 3

is a fragmentary view of a portion of the exterior of the device shown in Fig. 1, but provided with a different form of pressure indicating device. I

In the embodied form of the device illustrated by way of example in the accompanying drawings, a device is shown in a form especially adapted to be applied to one of the limbs of the human body. Said embodied formcomprises a cuff or envelop 1, preferably of flexible material, such as leather or other suitable material, adapted to be placed about the limb. Fastening de vices of suitable'form are provided which are ada ted or adjustable to fit the envelop to limbs 0 different sizes. As shown said fastening devices comprise spring hooks 2 which-engage with any one of a series of openings 3 to hold the cuff in general tubular form about the limb.

Within, that is upon the inner surface of,

the cuff or envelop l is provided a resilient bag or container 4 of suitable material,such as rubber or gutta percha. This resilient bag or container 4 communicates through an opening 5 with a conduit 6 connecting with a conduit 7 When the cuff 1 is placed about the limb the resilient bag or container 4.- is on the inside of the cuff and between the cuff and the limb. It will thus be understood, and will also be more fully explained hereinafter in connection with the use and operation of the device or apparatus, that by means of fluid pressure introduced into the resilient bag or container 4 pressure maybe applied to the limb until arterial pulsation is stopped or diminished to any desired degree in the limb beyond the point where such pressure is applied.

The amount or degree of pressure exerted by the bag or container 4, which acts to gradually decreaseand finally stop the blood circulation by pressure upon the exterior of the arm, may be indicated upon any suitable device.

So far as concerns certain features of the invention, such pressure indicating device may be of any convenient or approved form. In Fig. 3 a mercury manometer 11 is used for indicating the pressure, a flexible conduit 10 communicating between the conduit 7 and said mercury manometer 11. A suitable needle valve or other escape device 12 for the fluidin container 4 is provided and it may be conveniently placed on the pressure side or branch of the manometer 11, or at some other suitable point as on the cuff 1. A suitable stop-cock 13 may also be provided in the atmosphere or indicating branch of the manometer. A stop-cock 14 may also be provided to control the fluid pressure flow between the manometer and the conduit 7 and to prevent back flow of the mercury from the manometer. In accordance with one feature of the invention,

however, a pressure indicating device fixed to or mounted upon the end 1 is provided.

In Fig. 1 of the drawings I have shown an aneroid manometer 18 fixed to the extericr of the cufi' 1, and having suitable communication, preferably through the cuff, with the resilient bag or envelop 4. The aneroid manometer 18 maybe graduated to correspond to mercury millimeters, or otherwise as may be desirable or convenient. It presents the great advantage that the device is into the limb at each heart beat, and also indicating means in turn actuated or controlled by the flow of fluid to and fro result- 4: the limb entirely separate from the on ing from said movement of the limb. As embodied, a resilient fluid container is pressed against the limb so that its volume is changed by the pulsation in the limb, and a fluid reservoir not so pressed and changed is in communication therewith, and pulsation indicating means are provided interposed between said resilient container and said reservoir and in the to and fro flow of the fluid therebetween. These means act freely and independently to make the desired indications of existing conditions, as the blood flow is controlled in the manner desired by means of the device 4 and the coresilient bag or container 22 adapted to be placed under pressure between the limb and an exterior envelop farther from the heart than the container 4. So far as concerns certain features of the invention, the resilient bag or container 22 might be placed in side the cuff or envelop 1. In the preferred form of my invention, and as shown in the accompanying drawings, the resilient bag or container 22 is shown mounted upon the inside of a separate flexible cuff 23 likewise of leather or other suitable material. The cufl 28 may be connected to the cuff 1 by suitable flexible connections such as the hooks and loops 24 or-it may be placed u on 1. Thus the apparatus may be placed upon either side or both sides of the elbow or knee joint, which is of great convenience in the case of children and persons of small size The various conduits will, of course, be of proper length to allow the "arious arrangements or adjustments desired in any particular case. Thus the patient may be covered up after the cuffs are applied and the pressures manipulated and observations made outside the covers. It also furnishes a certain degree of independence between the flexible bags or containers 4 and 22 as they act upon or are acted upon by the pressure and pulsation of the blood in the limb. The

cuff 22 is provided with suitable fastening means such as the hooks 2 and eyes 3, as already described.

Referring further to the embodied form of the invention, shown by way of example in the accompanying drawings, a bag or reservoir 25 adapted to contain fluid under pressure is located so as not to be subjected to pressure between the cuff and the limb. By way of example, this container may be placed in any convenient position, at any distance from container 22 providing c0nduit connection 27 be sufliciently long for example the container 27 may be placed within the manometer case while the transparent tube 29 may be placed in an upright position along side of the mercury manometer, or it may remain unattached to any particular permanent part and be capable of being placed in any position convenient to the operator of the instrument. In the embodied form said bag or reservoir 25 lies or nests within a case or sheath upon the exterior of the cuff l. Ifdesired, it may be of rubber or it may be of other suitable material.

Means are provided for fluid pressure communication between the bags, containers or reservoirs 22 and 25, and also means actuated or controlled by the flow or interchange of fluid therebetween for indicating both the systolic and diastolic blood pressure. In the embodied form of such means, the bag, container or reservoir 22 communicates through an opening 26 with a conduit 27. The bag, container or reservoir 25 through a suitable mouth or opening 28 likewise communicates with the tube or conduit 27.

The embodied form of indicating means, before referred to, comprises a transparent tube 29 constituting part of conduit 27 and provided with graduations 30. Within the bore of said tube is located a body 31 adapted to be moved to and fro by the travel of the pressure creating fluid between the bags. containers, or reservoirs and 25. tube 29 may be of glass, and um? 5 ated in a well known main. l. The 'I'm body 31 may be a [)ltllbnii At ea id the tube 29 may be shaped to germli 24-. sage ofthe fluid while retain- 3 the z-ai u e within the glass tube.

Means are also provided for piecing an initial pressure within the reservoir a the conduit '27 is connected with, or may be regarded as a continuation of the conduit 7. A suitable fluid compressing device of any convenient or approved form may be employed and is shown herewith as a hand pump 35 connecting by a conduit 36 with the conduit 10. A suitable stop-cock 37 is located to permit the fluid under pressure to pass into each of the containers or reservoirs 22 and 25 at the same time that it is tainers 22 .and 25, and in the embodied term a passing into container 4, or to shut said fluid oil from said reservoirs or containers 22 and 25, while still leaving it to flow into the reservoir 4. A suitable stop-cock 38 may also be provided between the fluid compressing device and the apparatus.

The manner of operation of the hereindescribed apparatus is substantially as follows: The device is placed upon the limb and the cufi's 1 and 23 fastened by meansfof the respective hooks and eyes 2 and 3. The resilient containers or reservoirs 4 and 22 are thus between the inclosed limb and the inside walls of the respective cufi's 1 and 23. The cock 37 is open to permit the flow of the air or other fluid into all three of the reservoirs or containers. A certain amount of fluid under pressure is caused to flow into the containers or reservoirs until the container or reservoir 22 is firmly pressed against the surface of the limb but not sufficiently to shut ofl pulsations to the part below the cufl", and preferably until the maximum oscillation of the pith ball by the arterial pulsation is secured. The stop-cock 37 is then turned ofi', thereby shutting off the containers or reservoirs 22 and25 from the supply of fluid under pressure and also cutting them off from communicationwith the atmosphere but leaving them in communication with each other. While pulsation continues, the movement in the limb due to such pulsation causes compression and expansion of the container or reservoir 22 between the limb and the cufl 23 and there is a consequent flow of fluid toward and from the reservoir 25. This results in a pulsating or throb-like travel of the pithball 31, which movement is repeated at every pulsation so long as pulsations continue, the amount of travel of the ball being proportionate to the strength of the pulsation. The movement of the pith ball varies in .characteristics in accordance with the charcontinued until. the pressure upon the limb,

due to the expansion of the container or receptacle 4 between the cuff 1 and the limb stops the arterial pulsation in the limb below the container 4. The moment of ces-' sation of the arterial pulsation will beindicated by the cessation of movement of the indicating body 31 inthe tube 29. Thus there is provided an accurate visual, indi 'cator, controlled'directly from the enlargement and decrease in the volume or circum-- ierence offthe limb itself dueto the pulse BEST AVAILABLE COPY beat, by fluid pressure, and is much more accurate and reliable than the sense of touch or a mechanical recording or indicating device.

The moment .of cessation of the pulse beat coincides with the application of a pressure in the container or reservoir 4 equal to the systolic pressure. At this moment, which is indicatedas just described, the pressure is read upon the indicating device 11 or 18 as the case may be. This affords an exceedingly accurate and. refined means of determining the systolic pressure, and enables one observer to read the point of systolic pressure with as great a degree of accuracy as another observer, eliminating that degree of error which is introduced through lack of experience in blood pressure, dullness of tactile sensation, and variation in judgment, as to what constitutes true arterial pulsation or, in other words, eliminating almost entirely the personal equation of the observer. Further the indicating means is actuated by the flow of the whole volume of blood into thelimb and does not depend alone "on that portion which passes along the radial artery. I

In determining the diastolic pressure the shut oil is opened between containers 4, 22 and 25 so that the pulsations may cause the maximum flow of air to and fro through the tube 29 thus giving greater movement to the pith ball 31. The pressure of the fluid in the reservoir for container 4 on the limb is very gradually released by opening and closing the needle valve, and as said pressure is released arterial pulsations are resumed. It will'be understood, of course, that the systolic pressure on the manometer may be read at the moment of resumption of pulsation as well as at the moment of cessation thereof as previously described.

The renewed pulsation in the arm causes the to and fro movement of the fluid between the containers or reservoirs 22 and 25 and there is a corresponding pulsating reciprocating travel of the pithball 31, the travel of the ball along the tube being proportionate to the amount of arterial expansile movement or arterial collapse. As the fluid pressure is gradually released, the maximum movement or travel of the ball 31 is easily and accurately noted. At the point of maximum travel of the ball, the pressure is read upon the indicating device 11 or 18 as the' case may be and is noted as being the diastolic pressure. This is also rendered more accurate by the fact that the fluid container 22 is affected by the entire increase and decrease in the circumference of the limb due to arterial pulsation and the conduit between the two containers being of relatively small size, a very large travel of the ball is secured compared-to the amount of arterial movement and furnishes a much more reliable and accurate-means of measurement than is possible from the'manometer. It is not essential, in all cases, in determining diastolic pressures to open the containers 22 and 25 into communication with the container at, as the pressure may be released from the container 4, as previously described, while the containers 22 and 25 are still maintained cut off or separated from the container 4. It may be found advisable also in certain cases-to release a portion of the air only from the containers 22 and 25, to reduce their pressure slightly below that at which they were originally shut off from the container 4 and the fluid compressing means (which is preferably. the pressure of greatest excursion of the pithball) as hereinbefore described, in such case preserving the containers 22 and 25 cut off from container s but communicating with each other while the diastolic readings are taken.

By means of this invention, it will be understood that systolic pressure readin s are automatically indicated, thereby obviating errors arising from palpation with fingers or listening with the stethoscope. Further, blood pressure readings are standardized and the error resulting from the personal equation is eliminated, and the pressure readings are obtained from the whole volume of blood entering the limb rather than that passing through the radial or other particular artery. It will also be clear that diastolic pressure readings are made with as much accuracy as the systolic, and with the same advantages. By reason of the great palpabilityof the pulsation indicating devices, changes in pressure due to change in respiratory movements may be readily indicated so that a systolic reading may be determined for inspiration and one for expiration.

Other advantages and effects of the apparatus will be clear to those skilled in the art, or may. be learned by practice with the apparatus.

Itwill be understood that variations from the illustrated and described form may be made within the scope of the accompanying claims without departing 'from the principles of the invention.

What I do claim as my invention and desire to secure by Letters Patent, is

1. A blood pressure determining apparat-us including in combination means forapplying pressure to a limb of the human body to alter and to stop arterial pulsation in said limb, a resilient fluid pressure 'container and means for pressing it against said limb farther from the heart than said pulsation altering and stopping means, a container having means of communication with said resilient'container whereby fluid may flow from one of said containers to the other, respectively, during the expansile and BEST AVAILABLE COPY contractile movement of the limb during arterial pulsation, and pulsation indicating means actuated and controlled by the flow of fluid between said containers.

2. A blood pressure determining apparatus including in combination means for a plying pressure to a limb of the human bo y to alter and to stop arterial pulsation in said limb, a resilient fluid pressure container and means for pressing it against the said limb farther from the heart than said pulsation altering and stopping means, a container having means of communication with said resilient container whereby fluid may flow from one of said containers to the other, respectively, during the expansile and contractile movement of the limb during arterial pulsation, pulsation indicating means actuated and controlled by the flow of fluid between said containers, and means for measuring the pressure exerted by said pul sation altering and stopping means.

3. A blood pressure determining apparatus including in combination means for applying pressure to a limb of the human body to alter and to stop arterial pulsation in said limb, a resilient fluid pressure container and means for pressing it against said limb farther from the heart than said pulsation altering and stopping means, a container having means of communication with said resilient container whereby fluid may flow from one of said containers to the other, respectively, during the expansile and contractile movement of the limb during the arterial pulsation, pulsation indicating means actuated and controlled by the flow of fluid between said containers, and means for gradually reducing the pressure applied by said pulsation altering and stopping means.

4. A blood pressure determining a para; tus including in combination means or applying pressure to a limb of the human body to alter and to stop arterial pulsation in said limb, a resilient fluid pressure container and means for pressing it against said limb farther from the heart than said pulsation altering and Stoppmg means, a container having means of communicat on with said resilient container whereby fluid may flow from one of said containers to the other,

respectively, during the expansile and contractile movement of the limb during the arterial pulsation, pulsation indicating means actuated and controlled: by the flow of fluid between said containers, means for measuring the pressure exerted by said pulsation altering and stopping means, and means for gradually reducing the pressure applied by said pulsation altering and stopping means.

5. A blood pressure determining device including in combination a resilient fluid container adapted to be pressed against a limb of the human body and'to be changed in volume by the arterial pulsation in said limb, a fluid container having means of communication with said resilient fluid container, pulsation indicating means actuated and'controlled by the flow of the fluid between said containers, and means for controlling pulsation in said limb from a point between said resilient container and the heart. h

6. A blood pressure determming device including in combination a resilient fluid heart.

7. A blood pressure determiningv device including in combination a resilient fluid container adapted to be pressed against a limb of the human body and to be changed in volume by the'arterial pulsation in said limb, a fluid container having means of communication with said resilient fluid container, pulsation indicating means actuated and controlled by the flow of the fluid between said containers, and means for controlling pulsation in said limb byapplylng pressure thereto ata point between said resilient container andthe heart, and means -for measuring the applied pressure.

8. A blood pressure determining apparatus including in combination a resilient fluid container adapted to be pressed against. a limb of the human body and to be changed in volume by the arterial-pulsation in said limb, a fluid container having -means of communication with said resilient fluid container, pulsation indicating means actuated and controlled by thelflow of the fluid between said containers, and means for stopping pulsation in said limb by applying pressure thereto at a point between said resilient container and the heart, and means for measuring the applied pressure.

9. -A blood pressure determining apparatus including in combination a resilient fluid container adapted to be pressed against a limb of the human body and to be changed in volume by the arterial pulsation in said limb, a fluid container, a conduit, between said containers, meansv for indicating the movement of fluid in said conduit, a body movable to and fro in said conduit with the to and fro flow of fluid between-said con-v tainers, and means for controlling pulsation in said limb from a point between said re silient-container and the heart. j

' was soil-sunburn l .5111."

BEST AVAILABLE COPY tus including in combination a resilient fluid container adapted to be pressed against a limb of the human body and to be changed in volume by the arterial pulsation in said hmb, a fluid container, a transparent condult between said containers, a body movable to and fro in said conduit with the to and fro flow of fluid between said containers, and means for controlling pulsation in said hmb from a point between said resilient container and the heart.

11. blood pressure determining apparatus including in combination a resilient flu d container adapted to be pressed against a hmb of the human body and to be changed in volume by the arterial pulsation in said hmb, a fluid container, a transparent conduit between said containers, a body mov" able to and fro in said conduit with the to and fro flow of fluid between said containers, and means for controlling pulsation in said hmb by applying pressure thereto at a point between said resilient container and in .volume by the arterial pulsation in said limb, a fluid container, a relatively small conduit between said containers, a body movable to and fro in said conduit with the to and fro flow of fluid between said containers, and means for controlling pulsation in said limb from a point between said resilient container and the heart.

A blood pressure determining apparatus including in combination a resilient fluid container adapted to be pressed against a limb of the human body and to be changed in volume the arterial pulsation in said hmb, a fluid container, a relatively small condult bet-ween said containers, a body movable to and fro in said conduit with the to and fro flow of fluid between said containers, and means for controlling pulsation 1n sald limbby applying pressure thereto at 'a point between said resilient container and the heart, and means for measuring the applied pressure.

' 14. A blood pressure determining apparatus including in combination a flexible nonresilient cufl adapted to be placed about a limb of the human. body, a resilient bag w1th1n sa d cufl', a container, a conduit communicating between said container and said bag, pulsation indicating means controlled by the flow of fluid in said conduit, means for supplying fluid under pressure to said bag and said container,means for controlling the fluid pressure supply while leaving said bag and container in communication through said conduit, and means for apply ing pressure to said limb to control arterial pulsation therein from-a point'neare r the heart than said bag while said fluid pressure supply is cut off as aforesaid.

15. A blood pressure determining apparatus includin in combination a'flexible nonresilient cu adapted to be placed about a. limb of the human body, a resilient bag within said cufl, a container, a conduit communicating between said container-and said bag, pulsation indicating means controlled by the flow of fluid in said conduit, means :Eor supplying fluid under pressure to said ha and said container, means for cutting'ofl an turning on the fluid pressure supply while leaving said bag and container in communication through said conduit, and means for applying pressure to said limb to control arterial pulsation therein from a point nearer the heart than said bag while said fluid pressure supply is cut off as aforesaid.

16. A blood pressure determining apparatus includin in combination a flexible nonresilient cu adapted to be placed about a limb of the human body, a resilient bag within said cufl, a container, a conduit communicating between said container and said bag, pulsation indicating means controlled by the flowof fluid in said conduit, means for supplying fluid under pressure to said bag an sai lcontainer, means for cutting o'fl' the fluid ressure supply while leaving said bag an; container -1n communication through said :conduit, and means for applying pressure to said limb to control arter al ulsation therein from a point nearer the eart than said bag while said fluid pressure supply is cut of! as aforesaid, and means for measuring said pulsation controlling pressure.

' 17. A, blood pressure determining appas ratus including in combination a flexible A non-resilient cufi adapted to be placed about 'a limb -of the human body, a resilient bag within said cufl', a container, a conduit communicating between said container and said bag, pulsation indicating means controlled by the flow of fluid in said conduit, means for supplying fluid under pressure to said ha and said container, means for'cutting ofian turning on the fluid pressure supply while leaving said bag. and container 1n communication through said conduit, and means for applying pressure to said limb to control arterlal pulsation therein .from a point nearer the eart than saidbag while said fluid pressure suppl is 'cut as as aforesaid, and means for gra ually releasing said pulsation controlling pressure,

18. A blood pressure determinin apparatusin'cluding in combination a cu adapted to be placed about a human limb, a resilient ba within said cufl, a container carried out e exterior of said cufi, a conduit therebetween, means for supplying fluid un- 19. A blood derpressuretosaidbag and container, and I ulsation indicating means controlled'by the ow of fluid between said bag and, con tainer.- I

ressure determinin apparatus including in combination a on adapted to be placed about ahumanlimb, a re-- silient ba within said cufi, a container carrled, on t e exterior of said cuff, a conduit therebetween, means for suplplyingfluid under pressure to said bag an container, pulsation indicating means controlled by the flow of fluid between said ba and container, and a fluid pressure 'in icatin device fixed to the exterior of said on for measuring the pressure in said bag.

20. A blood pressure determining apparatus including in combination a flexible cufl adapted to beplaced about a human limb, a resilient bag within said cufl, a separate cuif adapted to be placed about the limb, a resilient bag within saidcufl, a fluid container without said cufis, means for supplying fluid pressure to said bags and container, and means for cutting of! one of said bags and said container from'said fluid prasure supplying means while leaving them in communication with each other and leaving.

the other of said bags in communication with said fluid" pressure supply.

21., A blood pressure determining apparatus including in combination a flexible cuff adapted to be placed about a human limb, a resilient bag within said cufl, a separate cufi adapted to be placed about the limb, a resilient bag within said cufi, a fluid container without said cufis, means for supplying fluid pressure to said bags and said container, and means for cutting off one of said bags and said container from said fluid pressure supplying means while leavin them in communication with each other an leaving the other of said bags in communication with saidfluid pressure supply, and means for measuring the amount of pressure ,on said last-mentioned bag.

22. A blood pressure determining ap aratus including in combination a flexi le cufi adapted to be placed about a human limb, a resilient bag within said cufi, a separate cut! adapted to be placed about the limb,- a resilient bag within said cufl', a fluid container without id cufis, means for supplying fluid pressure to said bags and said container, and means for cutting off one 01 said bags and said container from said fluid pressure supplying means while leavin them in communication with each other an leaving the other of said bags-in communication with said fluid pressure supply, means for measurin the amount of presure on said last-mentloned bag, and pulsation indieating means controlled by the flow of .fluid between said containenand the bag in'c0m-' munication therewith;

plying fluid pressure to said bags and said container, means for cutting off one of said bags and said container from said fluid pressure supplying means While leaving them in communicatlon -with each other andleav: ing the other of said bags in communication with said fluid pressure supply, means for,

BEST- AVAILABLE coPY measuring the amount of pressure on said last mentioned bag, pulsation indicating means controlled by the flow of .fluid. between said container-and the bag in communication therewith, and means for gradually releasing the pressure from said bag not in communication with said container.

In testimony whereof, I have signed my name to this specification, in the presence of two subscribing Witnesses. V

BERTIE RAYMOND HOOBLER. Witnesses? J OHNYD. MORGAN, ROSE MENK. 

